Dutch Health System Remains Europe’s Top Ranked

Author

Tosh Sheshabalaya,

For the second year in a row, the Netherlands has been judged to have
Europe’s best healthcare system, according to the annual Euro Health Consumer
Index. With a strong performance across all evaluation categories, the Dutch
scored an even larger margin than the previous year (when 3-5 countries were
clustered close to it at the top). Denmark, edged out of top slot in 2008, was
in second position this year. Though it remained at the top of the league in
terms of providing access to information and enforcing patient rights, it fared
weakly on the issue of waiting times.

One interesting finding: The Netherlands has shown a rise in healthcare
spending to the highest per capita levels in the European Union (excluding
Luxembourg, or non-EU members Norway and Switzerland – all of whose per capita
GDPs are far higher than the EU average).

The annual Euro Consumer Index, the fifth so far, provides a “user-focused,
performance-related” comparison of health services in 33 European countries.
The Index, traditionally based on evaluating criteria such as patient rights,
waiting times, outcomes, range of services offered, and access to medicines,
introduced the criterion of e-health last year - essentially, in terms of
electronic medical record usage and healthcare data exchange; this year, it
added a new sub-criterion under the e-Health rubric: e-solutions for communications
to patients.

The Netherlands was singled out by HCP due to recent reforms, which
have led to a central, strategic role for the patient/ health consumer. The
reforms blend competition for funding and provision within a regulated
framework. This separates financing of hospitals from their operation, and
removes decision-making from amateurs and transfers it to professionals. Alongside,
information tools (such as Kiesbeter – covered in a previous issue of
Healthcare IT Management) support active choice among consumers.

Indeed, the above recipe is more or less a model for countries in
the top quintile of rankings.

HCP said its league table serves as ‘a reality check’ for
governments who can use the data to benchmark themselves against Europe's best-performing
health systems.

HCP is critical of countries with GP gatekeepers, requiring patients
to visit family doctors before accessing specialist health services. This leads
to longer waiting times and does nothing to reduce costs. It is in this respect
that accessible information on hospital performance and greater patient choice
together lead to improvements in the efficiency of healthcare delivery.

Ironically, one of the countries that relies fairly heavily on GPs
as gatekeepers is EHCI’s top-ranked Netherlands. Not surprisingly, the country
shows a relatively mediocre performance in terms of waiting times and access.

As mentioned above, in 2009, the EHCI added ‘solutions for
communications to patients’ as a new metric. However, the choice of making
online comparisons of hospital outcomes is so far confined to a handful of EU
countries; apart from the Netherlands, they include Germany, Denmark and the
UK.

In the near future, the wider availability of such data will become
an increasingly important issue, after patients travel across European borders
for treatment, in line with the new EU directive on patient mobility.

According to the EHIC and other research, healthcare in Europe is
improving each year. However, public perceptions of health services remain poor
in several EU countries (not least Spain, Ireland and Greece), despite better EHCI
scores.

Given
below is an analysis by Healthcare IT Management of the performance of
different countries by key EHCI category:

Leaders: Denmark and
the Netherlands, followed by Croatia, Iceland, Sweden and the United Kindom.

Good Performers: Austria,
Finland, Macedonia and Norway.

Losers: Greece, slightly ahead of Albania, as well
as Belgium, Cyprus, Czech Republic and Slovakia.

[The nascent/emerging status of e-health is indicated by
a much lower rate of divergence between the leaders, losers and the median].

The origins of the Euro Health Consumer Index (EHCI) date back to
2004, when Sweden’s privately-owned Health Consumer Powerhouse (HCP) introduced
an index comparing Swedish county council responses to the care consumer
(Vårdkonsumentindex - VKI). The success of the VKI led to Swedish authorities
developing their own set of indicators for performance comparison, significantly
improving transparency in the healthcare system.

HCP extended the concept to a pan-European level in 2005 with its
first Euro Health Consumer Index (EHCI). Indices of performance in specific
healthcare needs (diagnoses, illness groups, care needs) are an added in
offering in its mission of “strengthening the position of the healthcare consumer.”

There is, nevertheless, an issue of semantics involved in the
indices, and rankings. HCP takes great pains to point out that EHCI does not
measure the best healthcare system, but rather the most consumer-friendly one.

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